Study: Higher ED use not caused by uninsured, immigrants

Contrary to popular perception, higher levels of uninsured, low-income, minority, and immigrant populations do not cause higher rates of emergency department (ED) use, according to an analysis of 60 American communities published July 18 by the journal Health Affairs.

Researchers from the Center for Studying Health System Change in Washington, DC, found an average of 32 ED visits per 100 people across all cities. Cleveland had the highest rate of ED visits per 100 people, 40, despite a lower-than-average uninsured rate. Orange County, CA, had the lowest rate, 21 ED visits, despite a higher-than-average uninsurance rate. Miami had an ED use rate of 25, despite having the highest levels of uninsured, low-income, Hispanic, and noncitizen populations of the cities analyzed.

The uninsured had roughly similar ED use rates to those with private insurance, and lower ED use rates than those with Medicare or Medicaid insurance. Noncitizens had much lower levels of ED use (about 17 fewer visits per 100, on average), than citizens, according to the study.

The study shows higher levels of ED use across all population demographics in high-use communities, reflecting "generic preferences and habits regarding use of EDs as a source of medical care for nonurgent problems."

"[Reducing] ED use defies simple solutions such as expanding insurance coverage or restricting access for undocumented immigrants," the researchers concluded.

Source: "What Accounts For Differences In The Use Of Hospital Emergency Departments Across U.S. Communities?" Health Affairs 25 (2006):w324-w336.